Eczema


Eczema, or dermatitis, is a reaction pattern that presents with variable clinical and histologic findings.

Atopic Dermatitis

Atopic dermatitis is one aspect of atopic triad of hay fever, asthma, and eczema. It usually presents as an intermittent, chronic, severely pruritic, eczematous dermatitis with scaly erythematous patches, vesiculation, crusting, and fissuring. Lesions are most commonly on flexures, with prominent involvement of antecubital and popliteal fossae; generalized erythroderma may occur in severe cases.

Management

  • Avoidance of irritants
  • Cutaneous hydration
  • Topical glucocorticoids
  • Topical calcineurin inhibitors like tacrolimus, pimecrolimus
  • Topical / oral antibiotics if lesions are infected
  • Systemic glucocorticoids only for severe exacerbations unresponsive to topical conservative therapy

Allergic Contact Dermatitis

Allergic contact dermatitis is a delayed hypersensitivity reaction that occurs after cutaneous exposure to an antigenic substance. Lesions occur at site of contact and are vesicular, weeping, crusting; linear arrangement of vesicles is common. Most frequent allergens are resin from plants of the genus Toxicodendron (poison ivy, oak, sumac), nickel, rubber, and cosmetics.

Management

  • Avoidance of sensitizing agent
  • Topical glucocorticoids
  • Consideration of systemic glucocorticoids over 2–3 weeks for widespread disease

Irritant Contact Dermatitis

Irritant contact dermatitis is inflammation of the skin due to direct injury by an exogenous agent. The most common area of involvement is the hands, where dermatitis is initiated or aggravated by chronic exposure to water and detergents. Features may include skin dryness, cracking, erythema and edema.

Management

  • Avoidance of irritants
  • Barriers (use of protective gloves)
  • Topical glucocorticoids
  • Systemic glucocorticoids for widespread disease
  • Treatment of secondary bacterial or dermatophyte infection

Seborrheic Dermatitis

Seborrheic dermatitis is a chronic non-infectious process characterized by erythematous patches with greasy yellowish scale. Lesions are generally on scalp, eyebrows, nasolabial folds, axillae, central chest, and posterior auricular area.

Management

  • Nonfluorinated topical glucocorticoids
  • Shampoos containing coal tar, salicylic acid, or selenium sulfide

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